蛇杖的傳人

Sherwin B. Nuland, "Doctors: The Biography of Medicine", Vintage Books, 1988
努蘭，《蛇杖的傳人——西方名醫列傳》，楊逸鴻等譯，聯經出版，1997

●The good physicians knows his patients through and through, and his knowledge is bought dearly. Time, sympathy and understanding must be lavishly despensed, but the reward is to be found in that personal bond which forms the greatest satisfaction of the practice of medicine. One of the essential qualities of the clinicians is interest in humanity, for the secret of the care of the patient is in caring for the patient.....(the dangers of "the science of medicine" to interfere with "the art of medicine")....they are not antagonistic, but supplementary to each other." (Dr.Francis Weld Peabody, lecture to Harvard medical students, 1927)

●Hippocrates

⊙The injunction to turn a blind eye to the possibility of a deity or mystical influence in the causes and treatment of disease was the greatest contribution made by the school of Hippocrates. The Swiss medical historian Erwin Ackerknecht has called it "Medicine's Declaration of Independence."(p.4)

⊙The Cnidian focus was on the disease, while that of Hippocrated was on the patient. The Cnidian physicians, like those of today, were reductionists, fine-tuners who directed their efforts to the classification of the processes of sickness and to exact diagnosis.(p.9)

⊙The Hippocratic physicians(Coan School) saw diseases as events that happen within the context of the life of the entire patient, and they oriented their treatment toward restoration of the natural conditions and defenses of the sick person and the reestablishment of his proper relation to his surroundings.....However, by concentrating their treatment not on the actual diagnosis but on the patient and his environment, and by making him a member of his own therapeutic team, they achieved successes that eluded their rivals; in this can be recognized the seeds of what has come to be called holistic medicine.(p.9-10)

⊙It became misinterpreted and garbled after the fall of the Roman Empire; then its distorted form refused to yield the stage for yet another thousand years thereafter. Having originally cleared the way for progress, Hippocartism was destined to become, in the end, and obstacle to the same kind of inquiring spirit which had given it birth.(p.10)

⊙The very first of those medical proverbs is the most quoted single statement in the entire collection of ancient medicine, perhaps of all medicine, or, as the Greeks were fond of calling it , the Art:

Life is short, the Art is long, opportunity fleeting, experience delusive, judgement difficult.(p.11-2)

⊙To the Hippocratic physician, the fundamental principle of his Art was the concept that Nature seeks to maintain a condition of stability....It is the function of the physician to help Nature restore the state of equilibrium. Since each disease has a distinctive natural course of its own, the physicain must make himself so familiar with it that he can predict the sequence of events and know whether and precisely when to interfere with treatment that will help Nature to do its work.(p.13)

⊙Its basic philosophy was the same as the basic philosophy underlying the rational understanding with which today's scientifically trained physicians approach the problems of sick people. In this view, disease should be looked upon as a combat between Nature and what may be called morbid causes. The role of the physician is to observe the struggle closely enough to know the propitious moment at which to interven, as well as to recognize that in most cases the intervention is best kept minimal, if indeed it is required at all. Sickness, it must be remembered, runs the gamut from colds to cancer. (p.15)

⊙The Hippocratic physician understood that the power which he called Nature is a formative, constructive, and curative power; the human body tends to heal itself.....it is most directly stated in the text of the book Epidemics(I,II):"To help, or at least to do no harm."...Primum non nocere—First, do no harm.(p.16)

⊙In the word of our ancient author:
Some patients, though conscious that their condition is perilous, recover their health simply through their contentment with the goodness of the physician.(p.17)

⊙To die would have been unfair to a doctor who gave so much of himself......"I did it for Bizzozero(intern); I couldn't let him down."(p.19)

⊙Some of those Hippocratic remedies became staples in the medical storehouse that would not be replaced for almost twenty-five hundred years. They included purgatives, emetics, baths, fomentations, bloodlettin, wine, bland drinks, and a calm atmosphere. Obviously, the purpose of much of this battery of available treatments was to aid Nature in her attempts to rid the body of excessive humors.(p.20)

⊙A director of surgical training in one of our great university hospitals would be hard put to improve on the counsel offered by Hippocrates two and a half millennia ago:
Practice all the operations, performing them with each hand and both together—for they are both alike—your object being to attain ability, grace, speed, painlessness, elegance, and readiness.(p.22)

⊙The chief reason for this error seems to me to be this: medicine is the only art which our states have made subject to no penalty save that of dishonor, and dishonor does not wound those who are compacted of it.("Law")(p.23)

⊙The classist Ludwig Edelstein has put forth the proposition that the catalytic factor in the development of Greek medical ethics was a thoroughtly practical one: a system of ethics set the Hippocratic physicians apart from those aforementioned charlatans with whom they were in competition.....It was a proof to patients and families that his doctor and his school typified a different order of healer than did the impostors who roamed the land in pursuit of the purses of the sick. In Edelstein's view, it was " an ethic of outward achievement rather than of inner intension."(p.23)

⊙Through him, healing is equated on the one hand with religion, and on the other with humanism—in his Precepts we read, "Where love of mankind is, there is also love of the Art."(p.24)

⊙（關於誓詞中禁止墮胎、協助自殺、摘取結石等事皆與當時希臘社會風氣相反，Nuland認為Hippocrates乃是根據"First do no harm"，從"principle of morality"與"principle of pragmatism"兩方面考量的結果） (p.28)

⊙In fact, the very nature of the professional brotherhood celebrated by the Oath encouraged consultation and fraternal discussion of cases, as did the words of the Corpus: "When a physician is uncertain as to the condition of a patient and is disturbed by the novelty of an affection that he has never seen before, he should never be ashamed to call in other physicians to examine the patient with him." (p.28)

●Galen

⊙All nature is but art, unknown to thee;
All chance, direction, which thou canst not see;
All discord, harmony not understood;
All partial evil, universal good:
And, spite of pride in erring reason's spite,
One truth is clear, whatever is, is right.(Alexander Pope)

⊙Uncritical faith, the basis of Jewish and Christian orthodoxy, was to Galen the enemy of true knowledge....The Hippocratic physicians had rejected supernatural forces in order to learn the ways of Nature; Galen studied Nature in order to learn the great and perfect ways of his Creator. Neither metaphysics nor miracles had any role to play. It was a credo worthy of a modern scientist.(p.34)

⊙The first, the most lasting, and the most pervasive of Galen's contradictory contributions, then was this: he used experiments and observation to learn about Nature, but he left a body of knowledge that he and his successors treated as a form of writ so conclusive that it inhibited further research for fifteen hundred years.(p.35)

⊙Conceived to demonstrate how God , in the words of De Usu Parium, "has shown His goodness in providing the happiness of all His creatures," Galen's researches into anatomy and physiology pointed the way to a new understanding of the body and how it gets sick. Perhaps it is he, and not Hippocrates, who deserves to be called the Father of Medicine.(p.37)

⊙When he was twenty-seven years old, a dream told him to open an artery in his hand to cure himself of an abdominal abscess; when he was thirty-eight, a dream told him not to go off to war with the Emperor Marcus Aurelius; when he was forty-three, a dream told him to complete an unfinished treatise on the structure and function of the eye. Throughtout his career he would from time to time use treatments revealed to him during sleep.(p.39)

⊙It has been charged that Galen feared more than assassination—that the real reason for his flight was the rapid approach of a major epidemic of plague that was overrunning the eastern part of the empire.(p.42)

⊙He was vain, petulant, contentious, impatient, quick to take defense. Proclaiming the wisdom of emulating God, who is without jealousy, he was the most jealous of men.(p.43)

⊙"It is impossible at the same time to engage in business, and to practice so great an Art."(p.44)

⊙Galen was primarily a theoretician, whose scientific method erred in two ways. First, he approached his observations teleologically—that is, he invoked on them a sense that they fulfilled some grand purpose. Secondly, by making good observation but not enough of them....(p.46)

⊙"if anyone wishes to observe the works of Nature, he should put his trust not in books on anatomy but in his own eyes and either come to me, or consult one of my associates, or alone by himself industriously practice exercises in dissection"(De Usu Partium)(p.47)

⊙"I firmly believe that if the whole materia medica as now used could be sunk to the bottom of the sea, it would be all the better for mankind—and all the worse for the fishes."(Holmes, 1860)(p.54)

●Vesalius

⊙Only the artists really needed to know anatomy. The physicians had no use for it except in the most general sense—everything they required was available to them in the writings of Galen.....there were the artists. They cared not a whit about Galen—they sought only the forma divina of their fellow man.(p.68)

⊙"During a period of some eleven or twelve years Vesalius worked under the spell of this intense drive for which he found such a happy outlet, almost completely converting the primitive, infantile, sadistic drives into highest endeavor; neither the skepticism of his friends not the open hostility of his colleagues and teachers seemed to deter him from his purpose. He stood before life as if conqueror of death itself, because it was out of the dead and decomposing body that he read the mysteries of living human functioning."(Zilboorg)(p.74)

⊙"Thus everything is wrongly taught, days are wasted in absurd questions, and in the confusion less is offered to the onlooker than a butcher in his stall could teach a doctor".(p.81)

⊙Fortunately, several Vesalian scholars have maintained enough historical objectivity to recognize that what appeared to be a sudden outburst of reckless impetuousity was actually a logical step in a long-standing life plan. Vesalius had always believed that the primary reason for knowing anatomy was to be a better doctor.(p.89)

●Pare

⊙When the early-nineteenth-century English surgeon Astley Cooper listed his colleagues' necessary attributes as the "eye of an eagle, heart of a lion, hand of woman", he diplomatically avoided the resentment of his medical colleagues by omitting what he knew to be his own most important attribute, the mind of a scholar.(p.95)

⊙During every major American conflict of the twentieth century, great advances have been made in some particular area of surgical treatment. In World War I, it was surgery of the intestine; in World War II, chest surgery; in the Korean war, vascular surgery; in Vietnam, rapid transport of trauma victims.(p.95)

⊙"this infernal engine roars as it strikes, and strikes as it roars, sending at one and the same time the deadly bullet into the breast and the horrible noise into the ear. Wherefore we all of us rightfully curse the author of so pernicious an engine; on the contrary praise those to the skies, who endeavor by words and pious exhortations to dehort kings from their use, or else labour by writing and operation to apply fit medicines to wounds made by these engines."(p.97)

⊙".....beyond my expectation I found those to whom I had applied my digestive medicine, to feele little paine, and their wounds without inflammation or tumor, having rested reasonable well in the night: the others to whom was used the said boiling oil, I found them feverish, with great pain and swelling about the edges of their wounds. And then I resolved with my selfe never so cruelly to burne poore men wounded with gunshot......See then how I have learned to dresse wounds made with gunshot, not by books...."...born the principle of gentleness in the treatment of wounds.(p.99)

⊙"The barbers tended unceasingly to approach the surgeons and to encroach on their domain; the surgeons sought at once to destroy or to submerge the barbers and to approach the physicians; and finaly the physicians, occupied at first only with repulsing and submerging the surgeons, later would be carried along by the force of things to use the barbers as assistants."(Montaigne)(p.103)

⊙Throughout his wrightings, Ambroise Pare reiterated again and again his simple credo as a surgeon: "I dressed him, and God healed him." Things are no different today....Though modern science is constantly decreasing the distance, the final cure remains largely in the contraol of as yet unknown factors at which we can only guess.(p.107)

●Harvey

⊙the young Belgian had done more than merely replace the ancient errors with facts; in disagreeing with revered authority, he had demonstrated the importance of skepticism, of believing nothing valid unless it could be verified by anyone who took the pains to evaluate evidence. More than anything else, he had created an atmosphere in which anyone who cared and dared to make independent observations was no longer hampered by the inherited erroneous speculations that were the accepted wisdom of the time.(p.121)

⊙"He was hot-headed, and his thoughts working would many times keepe him from sleepinge." (Aubrey)(p.126)

⊙"True philosophers, who are only eager for truth and knowledge, never regard themselves as already so thoroughly informed, but that they welcome further information from whomsoever and from wheresoever it may come; nor are they so narrow-minded as to imagine any of the arts or sciences transmitted to us by the ancients, in such a state of forwardness or completeness, that nothing is left for the ingenuity and industry of others. On the contrary, very many maintain that all we know is still infinitely less than all that still remains unknown; nor do philosophers pin their faith to others' precepts in such wise that they lose their liberty, and cease to give credence to the conclusions of their proper senses. Neither do they swear such fealty to their mistress Antiquity, that they openly, and in sight of all, deny and desert their friend Truth. .....I profess both to learn and to teach anatomy, not from books but from dissections; not from the positions of philosophers but from the fabric of nature;....I avow myself the partisan of truth alone; and I can indeed say that I have used all my endeavours, bestowed all my pains on an attempt to produce something that should be agreeable to the good, profitable to the learned, and useful to letters.

Farewell, most worthy Doctors, And think kindly of your Anatomist,

William Harvey."(p.137)

⊙If a single particular may be said to differentiate this developing science of the period from the thought patterns that preceded it, then it is this: the philosophers of the seventeenth century were more interested in answering questions that begin with the word "how" than in trying to figure out the "why"...."I own that I am of the opinion that our first duty is to enquire whether the thing be or not, before asking wherefore it is."....When one declaims of primary causes and reasons why, objectivity is lost and every observation is made to fit into a scheme in which all is preordained. The Hippocratic physicians had known better than to look for causes....
(p.140)

⊙to use Alexander Pope's term, he misunderstood "Whatever is" because he had predetermined what "is Right". William Harvey ...understood that it is not in the scientist's realm to learn "why", but only to learn "how"....characterized both poetically and very accurately by the English physiologist Sir George Pickering in his Harveian Oration of 1964 as "discipled curiosity".(p.140)

⊙"Nature herself must be our advisor; the path she chalks must be our walk. For as long as we confer with our our own eyes, and make our ascent from lesser things to higher, we shall be at length received into her closet-secrets."(preface to De Generatione Aninalium)(p.144)

●Morgagni

⊙anatomy is the key to diagnosis, and the physician's five senses are the key, as was first taught by the Hippocratis, to truth. Obviouly, it was not a message never heard before, but after Morgagni it could no longer be ignored.(p.149)（病理解剖）

⊙Although Morgagni was primarily an anatomist, his ultimate accomplishment arose out of his own sense that he was first and foremost a physician, one whose responsibility it is to care for the sick. Anatomy was his best tool in the effort to understand disease, and it was thus his means of becoming a better doctor.(p.151)（志為人醫）

⊙The specific pillars that supported it in his work were fourfold—clinical, pathological, experimental, and literary. Each of his seven hundred case reports details a clear clinical history followed by a report of the pathology found at autopsy. Relevant experiments are done where indicated, and a search is described of the extant literature on the subjects of investigation. This is the model for a form of teaching exercise that physicians of a later era came to call the clinicopathological conference, or CPC.(p.153)（臨床病理討論會）

⊙"Nature performs all her operations in the body by parts so minute and insensible that I think nobody will ever hope or pretend even by the assistance of glasses or other inventions to come to a sight of them."(John Locke!!)(p.155)（哲學家的錯誤）

⊙With the publication of "De Sedibus"(The seats and causes of diseases investigated by anatomy), the first distinct sounds of the humoral theory's death knell were heard. An entirely new basis had been presented upon which to understand the nature of disease. Henceforth, the human body was to be viewed as composed of a group of coordinated physical-mechanical structures working faultless harmony. These are the organs and the groups of organs which we call systems. The cause of disease would be seen, therefore, as a failure in some part of the machinery.(p.160)（器官論）

⊙the long-forgotten art of physical evaluation(Hippocratic) was about to revived and improved...(p.161)（理學檢查的復興）

⊙The patients, sometimes by name and always by occupation, figuratively step forth from the pages of text, bringing to mind that awe-inspiring statement that is to be found engraved on the walls of so many modern hospital autopsy rooms: Hic est locus ubi mors gaudet succurso vitae—This is the place where death rejoices to come to the aid of life.(p.166)（閱讀其病例的感動）

⊙（妓女與Marfan syndrome的首次提出）(p.166)

●Hunter

⊙"No natural phenomenon can be adequately studied in itself alone, but be understood must be considered as it stands connected with all nature."(Sir Francis Bacon)

⊙"He not only was not formed by his age, but in direct antagonism to it.....great men are not formed by the times they live in, but the times by them."(Edinburgh anatomist Robert Knox)(p.174)

⊙"When I was a boy, I wanted to know all about the clouds and the grasses, and why the leaves changed colour in the autumn; I watched the ants, bees, birds, tadpoles, and the caddis-worms; I pestered people with questions about what nobody knew or cared anything about."(p.175)

⊙surgery was not a calling noted for the material well-being..."not to provide its members bread until they have no teeth to eat."(p.180)

⊙"Men of genius do not excel in any profession because they labour in it, but they labour in it, because they excel."(William Hazlitt)(p.183)

⊙"A treatise on Venereal Disease"....a night with Venus lead to a year with Mercury.(p.184)

⊙inflammation as healing process/ transplantation /collateral circulation /artificial insemination /dentistry

●Laennec

⊙Die Frucht der Heilung waechst am Baume der Erkenntniss. Ohne Diagnostic keine vernuenftige Therapie. Erst untersuchen, dann urtheilen, dann helfen. (Carl Gerhardt, Wuerzburg, 1873)(p.200)

⊙"I have written I have proved again and again, by the testimony of my own senses, and amid laborious and tedious exertions;—still guarding, on all occasions, against the seductive influence of self-love." (Auenbrugger)(p.204)

⊙Since the hospitalized patient and his corpse at autopsy were the focus of instruction, the entering student was on the wards and in the dissecting rooms from the very first day of training. He was taught by the guiding precept "Read little, see much, do mush". In the early nineteenth century, this was an apt approach; most of what was then in clinical books was theoretical claptrap, not worth the value of the candle by which it was read.(p.212)

⊙Seemingly in the wink of an eye, the world of clinical medicine had undergone another of its great transformations—through the medium of a rolled-up sheaf of paper. What Laennec had invented was not merely an instrument by which the sounds of the body could be transmitted to the listener's ear—it was an instrument that would teach physicians the difference between evidence that is objective and evidence that can be influeced by the patient or the bias of the examiner.(p.220)

⊙hospital medicine....This was the period of history as well when the central point of medical research shifted from the patient to his diseasee. The doctors of the past had not understood that an entire organism can be made sick less because of general imbalances than because of very specific derangements of organs. First Morgagni and now the physicians of the Paris school sent out the ringing message that no progress would ever made in the treatment of people unless specificity took the place of generalities, unless the particular source of every symptom could be found, and unless the diagnostic vision of the healers was permitted to narrow itself to a much smaller and therefore more brilliantly illuminated focus. The Cnidian philosophy had to be allowed to overcome the Coan.....we may be approaching in the twenty-first century a new era of Hippocartism.(p.232)

⊙Pierre Louise...began one of his books with a quotation from Rousseau...."I know that the truth is in the things, and not in my mind which judges them. The less I put of my own into these judgements, the surer I anm to approach the truth." This was a declaration of objectivity.(p.232)

⊙The excellence of Laennec as a teacher and diagnostician does not mean that he had much more to offer his patients, once diagnosed, than had his hero Hippocrates twenty-three hundred years earlier.(p.234)

●Semmelweis

⊙"Genius was priceless, beneficent, divine, but also was, at its hours, capricious, sinister, cruel; and natures ridden by it, accordingly, were alternately very enviable, and very helpless."
(Henry James, Roderich Hudson)(p.238)

⊙"Herr Professor(Josef Spaeth), you have convinced me that the Puerperal Sun which arose in Vienna in the year 1847 has not enlightened your mind even though it shone so near to you....This arrogant ignoring of my doctrine, this arrogant boasting about errors, demands that I make the following declarations..."(p.257)

⊙Even when victory was at hand, his self-concept of being a defeated, clumsy outsider was too strong....could see himself only as a pride-injured, contentious outsider, never as a victorious professor in Vienna.(p.261)

●Anaesthesia

⊙Crawford Williamson Long(1815-78):
→There is no better example to be found of Pasteur's maxim "Where observation is concerned, chance favors only the prepared mind" than the use to which this highly trained physician put his experience.(p.280)

⊙Dr. Horace Wells
→In one stroke, Wells' prize had been stolen from him, and he had been offered the crumb of a subservient role by the very same ungrateful protege to whom he himself had introduced the concept of pain-free surgery. His distress was made all the more bitter by Morton's having snatched not only the glory but the gold as well.(p.284)

⊙Dr. William T.G. Morton
→he was, pure and simple, an inventor looking for a bonanza.(p.285)

⊙Dr. John Collins Warren
→quietly announced the birth of anesthesia with an eloquently simple testimony: "Gentlemen, his is no humbug."....the Ether Dome(p.289)

⊙Charles T. Jackson
→none of the four contenders for the crown of discovery had an easy life after the controversies began(p.301)

⊙the world of discovery is still very much the world of the young, and so it will always be.(p.302)

●Virchow

⊙"Once we have recognized that disease is naught else than the process of life under altered conditions, the concept of healing expands to imply the maintenance or re-establishment of the normal conditions of existence."(p.304)

⊙Virchow outlined his perception that disease is not an aberration engrafted onto a healthy organism, but is simply health disordered. The dominant theorists of his day viewed sickness as a condition quite foreign to the normal functioning of tissues....By this formulation, diseased structures are so different from healthy one that nothing can be learned about the one by studying the other....(p.312)

⊙"Sickness is dependent upon the blunders of society."(Pierre Cabanis)(p.316)

⊙Not only typhus, but cholera, tuberculosis, scurvy, some mental diseases, and even cretinism were included in his list of those many maladies that result from the unequal distribution of civilization's advantages...."Physicians are the natural attorneys of the poor."(p.316)

⊙"The improvement of medicine would eventually prolong human life, but improvement of social conditions could achieve this result more rapidly and more successfully."(p.316)

⊙Omnis cellula a celula, every cell comes from a previously existing cell. Without equivocation, he affirmed the inevitability of his conclusion: "No matter how we twist and turn, we shall eventually come back to the cell."(p.323)

⊙"His was an eagle's eye, that saw deep into the most secret reaction of the sick organism, and traced the grey footprints of death and disease over the flower-strewn fields of life...He never rested in his efforts to trace the dragon of sickness ot its remotest lair...." (Schleich)(p.325)

⊙"This book(Cellular pathology) deserves to be placed with Vesalius' Fabrica, Harvey's De Motu, and Morgagni's De Sebibus...as the greatest tetrad of medical books since Hippocrates."(Krumbhaar)(p.324)

⊙there were always a few investigators whose efforts had paralleled his. But for accidents of timing and the vagaries of research, for example, we would today credit much of the cell theory to the German scientist Robert Remak or the Englishman John Goodsir....Erwin Ackerknecht, has stated: "In addition to the fact that Virchow's findings were more meaningful, he propagated them with that tireless zeal and almost sinister energy in which nobody has ever excelled him."(p.335)

⊙"The development of nations must find its highest goal in a humane understanding, which raises the individual far above the narrow confines of nationalism to the highest realms of humanity." (p.342)

●Lister

⊙"If we had nothing but pecuniary rewards and worldly honors to look to, our profession would not be one to be desired. But in its practice you will find it to be attended with peculiar privileges, second to none in intense interest and pure pleasure. It is our proud office to tend the freshly tabernacle of the immortal spirit, and our path, if rightly followed, will be guided by unfettered truth and love unfeigned."(graduation address)(p.360)

⊙As has so often happened in the history of science, it had taken the tragedy of war to provide a setting in which innovation could emerge. In the brief but ferocious Franco-Russian War of 1870-1, the few surgeons who used Lister's methods had been able to demonstrate mortality statistics that were much better than those of the great majority of their colleagues.(p.373)

⊙There was one other major factor in the foot-dragging of the English and of the Americans as well: they were resisting a powerful and ultimately overwhelming movement which was already begining to permeate the atmosphere of German surgery. By this I mean the new order of things, in which the careful, meticulously executed operations permitted by antisepsis and anaesthesia were replacing the old emphasis on speed and dazzling dexterity.(p.379)

⊙It now became Joseph Lister's turn to be superannuated. The very germ theory upon which Listerism was founded demanded that aseptic methods should replace antisepsis. In effect, asepsis is prophylaxis, while antisepsis is therapy....Ultimately, Joseph Lister deserved the encomiums of a grateful humanity not because of his methods, but because he awakened his fellow surgeons to the real cause of putrefaction and led them into scientific pattern of thought by which it could be prevented.(p.382)

●Halsted

⊙though he was probably cocaine-free after settling in Baltimore, Halsted remained morphine-addicted the rest of his life. He was brought to Hopkins not to become a Professor of Surgery, but rather to pull together the shattered bits of his life....."a form of occupational therapy" and most certainly not an academic appointment.(p.399)

⊙There is no single factor that has been more instrumental in the rapid rise of American medicine to its present world preeminence than the principle enunciated by Hopkins: each medical school must not only be part of a university environment, but must be so closely affiliated with an excellent hospital that the two are for all intents and purposes part of the same tripartite endeavor of healing, teaching, and research.(p.399)

⊙Observers no longer expect to be thrilled in an operating room; the spectacular public performances of the past, no longer condoned, are replaced by the quiet, rather tedious procedures which few beyond the operator, his assistants, and the immediate bystander can profitably see. The patient on the table, like the passenger in a car, runs greater risks if he have a loquacious driver, or one who takes close corners, exceeds the speed limit, or rides to admiration.(Harvey Cushing,1913)

●Taussig

⊙Thalidomide（造成海豹肢）回收/ 促使人工流產法禁制放鬆減少畸胎

⊙"We are still fighting the Right to Life group, who are so completely convinced that life is sacred from the moment of conception till birth. As far as I can see, after birth they don't care a hang what happens to the child or what sort of a child is born. They take no more care until the person is dying and then they absolve him from sin."(p.452)

●Transplantation

⊙"The singular character of the individual entirely dissuades us from attempting this work on another person. For such is the force and power of individuality, that if anyone should believe that he could accelerate and increase the beauty of union, nay more, achieve even the least part of the operation, we consider him plainly superstitious and badly grounded in the physical sciences."(Tagliocozzi)(p.465)

⊙The story of transplantation becomes, therefore, the story of our evolving comprehension that the cells of each of us harbor within them something that is theirs alone, which gives them their unique, unchanging character..."selfness".(p.465)

⊙A third-world dictator shouts a few anti-American imprecations, and our government spends enough money moving warships to pay a years's rent on every federally funded pediatric cardiology clinic in the nation....It is not the doctor who will decide, nor should he; it is society.(p.486)

2004.10.5
立人祕密書齋